Imatinib and Apixaban: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Aug 8, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Imatinib
Apixaban
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
If you take Eliquis (apixaban), a blood thinner, along with Gleevec (imatinib), a cancer medicine, the two can interact. Imatinib can slow down a transporter in your body that normally helps clear apixaban out. That means more apixaban can build up in your blood, which can raise your chance of bleeding, like easy bruising, nosebleeds, or bleeding that is hard to stop.
This concern is based mostly on how the drugs are expected to behave, not on strong studies. Please don't change anything on your own. Your care team can manage this, sometimes by choosing a different medicine or watching you more closely. Just make sure both your doctor and pharmacist know you take both.
Effect: Increased apixaban exposure via imatinib-mediated inhibition of P-glycoprotein (P-gp) efflux transport. Apixaban is a P-gp substrate; imatinib is a P-gp inhibitor. Neither drug's anticoagulant activity depends on metabolic activation, so reduced efflux increases apixaban plasma levels and bleeding risk.
- Direction: Increased apixaban AUC/Cmax, enhanced anticoagulant effect.
- Severity: Major. Evidence: Theoretical. Onset: Unspecified.
- Management: Per label guidance, coadministration should generally be avoided. If unavoidable, monitor closely for bleeding; dose may need individualization by the care team. Consider an alternative anticoagulant or antineoplastic where clinically appropriate.
What happens
Increased apixaban exposure
Interaction Deep Dive
Because apixaban is a substrate of P-gp and imatinib inhibits P-gp, taking the two together can raise apixaban concentrations and elevate the likelihood of bleeding; for this reason, their coadministration should be avoided1.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of apixaban
How to manage this interaction
Here is how a care team usually handles this combination:
- Avoidance is preferred. Because imatinib can raise apixaban levels, your prescriber may choose a different blood thinner or a different plan if possible.
- Closer monitoring. If you do take both, your team may watch you more closely for signs of bleeding.
- Report symptoms: unusual bruising, nosebleeds, pink or red urine, black stools, or bleeding that won't stop.
Keep taking both exactly as prescribed unless your doctor or pharmacist tells you otherwise, and let them know you are on both so they can tailor your care.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Imatinib and Apixaban together?
Imatinib can raise apixaban levels and increase bleeding risk, so this combination is generally avoided; talk to your doctor or pharmacist before changing anything. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Imatinib and Apixaban interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Imatinib and Apixaban interaction managed?
Here is how a care team usually handles this combination: Avoidance is preferred. Because imatinib can raise apixaban levels, your prescriber may choose a different blood thinner or a different plan if possible. Closer monitoring. If you do take both, your team may watch you more closely for signs of bleeding. Report symptoms: unusual bruising, nosebleeds, pink or red urine, black stools, or bleed… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Imatinib or Apixaban need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Steffel J, Collins R, Antz M, et al: 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021; 23(10):1612-1676.
Keep reading about Imatinib
Keep reading about Apixaban
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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